Santa Clara health system and Optum tackle the most complex of complex populations

Healthcare is asked to do a lot.

In its quest toward value-based care, it must look at the whole person. It's no longer about treating systems. Providers must treat social and behavioral needs, housing, transportation, energy assistance, food insecurity and nutritional support.

In many cases, funding for these social determinants of health is resulting in a return on investment, both financially and in better outcomes for patients.

As the number of patients with comorbid conditions increases, so does the complexity of targeting the individuals in greatest need.

Santa Clara Valley Health and Hospital System, a large safety net organization in California, sees numerous patients in need of whole person care, as 90 percent of its population is served under Medicaid.

Medicaid beneficiaries are high utilizers of the health system. Many  have comorbid conditions. They're less visible, have poor medication adherence and in some cases, are homeless, said Teddy Shah, vice president of Optum Advisory Services.

Santa Clara recently implemented specific strategies to address the social, clinical and behavioral needs of their high-risk Medi-Cal beneficiaries through a program sponsored by the State of California.

The health system got a $1.5 billion federal grant over five years to target the complex needs of its Medicaid population.

Optum is building the technical structure and has created a framework conceptual model that has the patient at its center.

"It's new as a concept being put together holistically," Shah said. "It's really changing the direction of cost of care. It's the most complex of the complex patient population."

First, inpatient and outpatient organizations, which are not always under the same executive leadership, need to talk to each other to identify the patients most in need of attention, Shah said.

There's also various care manager programs, behavioral health and other services that need to be coordinated for a managed care plan.

Optum created an integrated care center.

What's been developed can also eventually be applied to less complex populations, such as in the commercial market, Shah said.

Now a year-and-a-half into the five-year plan, Santa Clara's medical director Dr. Jeffrey Arnold and Shaw will present their findings during the session titled "Bending the Cost Curve with Whole-Person Care," at HIMSS19 in Orlando on February 12 from 4:15-5:15 p.m.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com